Soft and flexible surface: – ft lbs. With increasing force get simple linear fracture, circular fracture and stellate fracture. With smaller surface area get depressed skull fracture. Growing fracture: entrapment of dura in fracture line or escape of blood from an epidural through a fracture to create a scalp hematoma results in enlargement of the fracture after healing as the periosteal edges are deprived of the dural-based blood supply. Type III coronal but not through sella. Type I most common: assoc impact on side of head or on tip of chin. Ring fractures: impact to vertex, buttocks or tip of chin.
A home for paediatricians. A voice for children and youth.
Child abuse is a problem of particular concern to physicians and other professionals caring for children. Symptoms of physical abuse in children, especially infants, are often nonspecific and may overlap with numerous other clinical conditions. Therefore, radiologists play a key role in identifying imaging findings to make the diagnosis of physical child abuse. Although many injury patterns may be seen with both accidental and nonaccidental trauma, there are some characteristic findings and injury patterns of abuse that should be recognized by radiologists who interpret pediatric imaging studies.
This review covers the characteristic imaging manifestations of child abuse, as well as diagnostic pearls, pitfalls, and limitations associated with skeletal, intracranial, spinal, and abdominal injuries. Aside from cutaneous findings, such as bruising and contusions, fractures are the next most common findings in abused children.
– Multiple long bone fractures + chronic subdural haemorrhage(s) Bruising does NOT necessarily imply underlying fracture Dating Skull Fractures.
Reprinted with permission of the American College of Radiology. No other representation of this material is authorized without expressed, written permission from the American College of Radiology The babygram , which is a single image of the entire chest and abdomen as well as the extremities, is inadequate. Peripheral areas are incorrectly exposed, and subtle fractures can be missed. Proper radiographic technique, positioning, collimation, and shielding are vital to optimize visualization of osseous structures and allow diagnosis of pathology with high sensitivity while keeping radiation dose levels within acceptable limits.
A follow-up skeletal survey, usually in 2 weeks, may increase the diagnostic yield, particularly if findings are equivocal on the initial study and there is strong clinical suspicion for abuse. The repeat study also helps with accurate dating of individual injuries. Although the complete skeletal survey is almost always mandatory in suspected child abuse cases for patients under 2 years of age, its utility diminishes and provides little value after age 5.
Between the ages of 2 and 5 years, imaging is guided by specific clinical indicators of abuse and should be individually prescribed [ 10 ]. Bone scintigraphy is generally limited in the evaluation of non-accidental injury. Its primary use is in the identification of subtle rib fractures, but it is not particularly good at demonstrating epiphyseal and metaphyseal fractures, as these areas are obscured by normal physiologic activity and high periphyseal uptake of radiopharmaceutical [ 11 ].
Skull fractures are notoriously difficult to visualize on routine bone scans [ 12 ]. Equally important, bone scans require sedation and expose the child to a relative high radiation dose [ 13 ]. They are mainly used if clinical suspicion is high and routine imaging fails to document acute or healing fractures.
Diagnostic Imaging in child abuse
Battered child syndrome, shaken infant syndrome, stress-related infant abuse and non accidental trauma are all terms to describe the complex of non-accidental injuries in infants and young children as a result of abuse. The term shaken infant syndrome probably best describes the classic pattern of injuries. The child is held around the chest and violently shaken back and forth. This causes the extremities and the head to flail back and forth in a whiplash movement.
Intracranial injury occurs as a result of severe angular acceleration, deceleration and direct impact as the head strikes a solid object.
reaction assists in dating metaphyseal fractures. Vertebral and skull fractures cannot be reliably dated, although soft tissue. (scalp) swelling over a.
E-book mobile version. Index of Core Concept Chapters. About Core Concepts. Non-Accidental Musculoskeletal Injuries. I n a clinical setting where musculoskeletal injury is the chief complaint, it is imperative to maintain a threshold of suspicion for physical abuse as the primary cause of an injury. Non-accidental injuries may be difficult to recognize since caretakers rarely disclose maltreatment, some children cannot provide a history, and signs and symptoms of physical abuse may be subtle or confused with other common pediatric diagnoses.
Corner fracture, also known as bucket handle fracture, is a metaphyseal fracture that is pathognomonic of non-accidental trauma. Image source: Radiology Assistant. Scapula fractures c. Spinous process d. Sternum fractures e. Skull fractures f. Multiple fractures in various stages of healing g. Bilateral fractures h.
Aging After Brain Injury: BrainLine Talks with Dr. Steven Flanagan
Know more. This judgment was delivered in private. The judge has given leave for it to be reported on the strict understanding that irrespective of what is contained in the judgment in any report no person other than the advocates and any other persons identified by name in the judgment itself may be identified by name and that in particular the anonymity of the children, the adult members of their family and their location must be strictly preserved.
A local authority applies to the court for care orders in respect of two children, W aged 2 and B aged 8 months. The case comes before me for a finding of fact hearing.
Skull fractures can lead to an early death, even if the victims initially at skulls from three Danish cemeteries with funeral plots dating from the.
Skull fracture. Basilar skull fracture ; Depressed skull fracture ; Linear skull fracture Skull fractures may occur with head injuries. The skull provides good protection for the brain. However, a severe impact Infant skull fracture image.
Bilateral skull fractures in infancy may result from accidental or abusive injury. Consultation with a child abuse pediatrician may assist with determining the likelihood of accident or abuse. Diagnostic considerations for the infant with bilateral skull fractures are reviewed, including single impact, double impact, and compression mechanisms of injury, as well as the possibility of accessory sutures as skull fracture mimics. Illustrative cases exemplify the evaluative process, including obtaining a detailed history, assessing for the presence or absence of additional physical or radiographic signs of injury, screening for psychosoical risk, and obtaining three-dimensional reconstruction of CT bone images.
Skull. – Ribs. – Spinal column. What are we missing? Specificity of Infant Fractures for Of all the fractures described in child abuse, none appears more specific than the Chapman S. The radiological dating of injuries.
Skull fractures are common injuries in young children, typically caused by accidental falls and child abuse. The paucity of detailed biomechanical data from real-world trauma in children has hampered development of biomechanical thresholds for skull fracture in infants. The objectives of this study were to identify biomechanical metrics to predict skull fracture, determine threshold values associated with fracture, and develop skull fracture risk curves for low-height falls in infants.
To achieve these objectives, we utilized an integrated approach consisting of case evaluation, anthropomorphic reconstruction, and finite element simulation. Among the predictor candidates, first principal stress and strain correlated best with the occurrence of parietal skull fracture. Risk curves using these predictors determined that infant falls from 0.
Head-first falls from 0. Probabilities of fracture in 0. Occipital impacts from 0. These data represent a multi-faceted biomechanical assessment of infant skull fracture risk and can assist in the differential diagnosis for head trauma in children. Historically, an accidental fall is the most common history provided for the mechanism of injury in infants diagnosed with abusive head trauma [ 3 ].
Therefore, a detailed understanding of the biomechanics of low-height falls in infants and associated skull fracture risk is critical for informing the differential diagnosis between accidental and abusive head injury etiologies, and for identifying strategies for injury mitigation in household and recreational settings. Given ethical restrictions for conducting controlled falls in children, pediatric biomechanics of falls are investigated using case reports [ 4 , 5 ], retrospective clinical studies [ 6 , 7 , 8 , 9 , 10 , 11 ], anthropomorphic surrogate drop tests [ 12 , 13 , 14 ], cadaver drop tests [ 15 , 16 , 17 , 18 ], or finite element FE model simulations [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ].
By themselves, each of these types of studies have limitations.
Medieval Skulls Reveal Long-Term Risk of Brain Injuries
Long-time readers will have been enjoying the regular frank exchange of views and pleasantries between Mostyn J and the Court of Appeal, but this is a new one. Thus, it is clear that in all civil proceedings P cannot be set higher than a scintilla above 0. The requirement of evidential clarity is quite distinct from an elevation of the probability standard. This would be absurd and perverse. The second reason is that the dictum can only apply when all relevant facts are known, so that all possible explanations, except a single extremely improbable one, can properly be eliminated.
A case based on circumstantial evidence depends for its cogency on the combination of relevant circumstances and the likelihood or unlikelihood of coincidence.
to injury and the injuries which caused the fractures Most accidental skull fractures result from falls and so the accurate dating of fractures is mandatory.
Where a skull fracture is identified in a child, there will be concerns about how it has been caused and whether it was a result of non-accidental injury. If a non-accidental injury is suspected within care proceedings, often a medical expert neuroradiologist will be instructed to consider the injury and any explanations for it. I hope the following may explain a little about the skull and skull fractures.
As the largest bone, the parietal bone is the most likely bone to fracture in an accident. Subsequently, suspicion often arises if it is one of the other bones that has fractured. Unless there is some kind of underlying bone disease, a skull fracture means that there has been an impact to the head of some kind. Whether this impact is a result of an accident or NAI will need to be fully explored.
The radiological changes in a long bone for example the femur give indications of how old a fracture might be. The skull is very different and a fracture here can look the same for weeks. This makes any attempt to date it very difficult and dating on radiology alone is therefore unreliable. Doctors will often look for clinical signs of injury to assist them with providing approximate dates of when the injury occurred.
Scalp swelling is one of these clinical signs and although it is not always present, a lack of swelling does not exclude the possibility of a fracture. Swelling can happen almost immediately after an incident or it can appear or grow over the next hours.